Healthcare Provider Details

I. General information

NPI: 1760255707
Provider Name (Legal Business Name): ALEX CARINO REGACHO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 ARNOLD DR
MARTINEZ CA
94553-4189
US

IV. Provider business mailing address

1340 ARNOLD DR
MARTINEZ CA
94553-4189
US

V. Phone/Fax

Practice location:
  • Phone: 925-313-9562
  • Fax:
Mailing address:
  • Phone: 925-313-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number502635
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number502635
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number502635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: